May Message from Steven L. Strongwater, MD, CEO
The information below is an employee update of activities at Stony Brook University Medical Center prepared by Stony Brook University Hospital CEO, Steven L. Strongwater, MD. Dr. Strongwater distributes a monthly update which is sent to all hospital faculty and staff to communicate initiatives and activities undertaken at the Medical Center to reach goals in the areas of patient satisfaction, patient safety, and community connections.
May 2009
This has been a challenging month. Stony Brook University Hospital (SBUH) is busy. The Emergency Department is crowded with patients in need. Demand for medical care is forecasted to rise, yet, as reflected in the New York State Budget, there is a lack of understanding of our role in Suffolk County because there will be significantly less money to provide care in the upcoming fiscal year. With less support, ultimately, the needs of more than 1.5 million residents in Suffolk County will be impacted.
As it stands, the State budget incorporates direct cuts to SBUH of $15.3 million beginning in April 2009. This is a result of changes in the Medicaid program ($4.7 M) and a reduction in State Sponsorship of $10.5 M (State Sponsorship is intended to recognize State University of New York/SUNY) hospital labor costs, which are higher because of negotiated labor packages by the State. Based upon prior commitments, this creates an unfunded need of an additional $26 million, leading to a total gap of $41.3 million in SBUH’s budget. In recognition of these cuts, the State is accelerating payments due from the State for expenses SBUH incurred providing indigent care in the past. This support is short lived and falls short of our needs now and in the longer term.
We are grateful to our legislative representatives Senators LaValle, Foley, and Flanagan and Assemblyman Englebright, who battled to restore these cuts, but have been unsuccessful. The Hospital Association of New York State (HANYS) and the Greater New York Hospital Association (GNYHA) have also failed to restore these cuts. The federal intent of the “stimulus” money was supposed to assure healthcare and education in this time of need. Something has gone terribly wrong.
As shared in earlier communications, SBUH has been working for months in anticipation of a reduction in State support. Fortunately, we identified $18 million dollars in savings. If you say this quickly, it sounds easy and as if we have this available and already in the bank. In reality, we don’t. We have a plan to remove $18 M from our expenses, but it will require a great deal of work and commitment. Even with this plan, we are still short. I am confident we will find a way to get through this upcoming fiscal year. Somehow. We will need your flexibility and insights as we sort through a limited set of additional options. Continued growth in admissions is a key part of the plan. Please help us share the good news about the quality of SBUH services and the advanced skills and quality of our staff. There is so much to be proud of.
We encourage and welcome your suggestions for enhancing our growth, increasing our revenues and reducing expenses. Please share your ideas by visiting our Intranet (http://inside.hospital.stonybrook.edu/sbuh/intranet) and click on “Cost Savings and Revenue Enhancement Suggestions.” Thank you.
STONY BROOK PRIDE
ALS Clinic—A Center of Excellence. The ALS Association has certified SBUMC’s ALS (amyotrophic lateral sclerosis) Comprehensive Care Clinic—the only one of its kind on Long Island—as its 34th Center of ExcellenceSM in the nation. The certification recognizes the Center as providing the best care possible to those fighting Lou Gehrig’s disease. Visit www.alsa.org to view the ALS Association’s home-page story. Congratulations to Dr. Rahman Pourmand, Director of the ALS Clinic and Stony Brook University Medical Center’s (SBUMC’s) Neuromuscular Disease Center, and the entire staff at the ALS Clinic.
SBUMC Cancer Program recognized for excellence. The Commission on Cancer has awarded SBUMC’s Cancer Program its Outstanding Achievement Award (OAA) for exceptional performance. Ninety-five programs—19 percent of the 478 programs surveyed during this period—received the award as a result of surveys performed in 2008. To earn the OAA, a facility must demonstrate a commendation level of compliance with seven standards that form the basis of the award criteria. In addition, the facility received a compliance rating for the remaining 29 cancer program standards.
SBUMC guidelines published. “Guidelines for Reducing Sepsis Mortality” were published in the American Hospital Association Pursuit of Excellence, a strategic platform to identify and disseminate field-tested practices, proven strategies, tools, and resources that can support and advance ongoing efforts to achieve performance excellence. Congratulations to the team members!
Mortality rates continue to improve. SBUMC was one of only a handful (less than 200 out of approximately 4,000) facilities nationwide showing significant improvement for both acute myocardial infarction and community-acquired pneumonia mortality rates as reported by the Centers for Medicare and Medicaid Services. For congestive heart failure, the Medical Center was statistically on par with the national numbers. Three years of discharge information were factored into the data.
New role established to support development of surgical departments. Dr. George Tyson has been appointed Associate Director, Surgical Strategy and Program Development. In this new role, Dr. Tyson will work with the surgical chairs and appropriate faculty and administrators to facilitate program development, assist with strategic planning, develop capital plans, and provide advice regarding quality of care and potential cost containment opportunities. Dr. Tyson is well known, having been at SBUMC for 25 years, and has served in numerous leadership positions. Congratulations to Dr. Tyson as he enters into this role.
SBUMC physicians are honored on National Doctors Day. In recognition of National Doctors Day on March 30, 40 SBUMC physicians were honored by grateful patients, family members, and loved ones. Each physician received a special certificate to commemorate the day.
Catherine Morris recognized for excellence in case management. Associate Director for Care Management, Catherine was named the 2009 National Case Manager of the Year (CMOY) by the Case Management Society of America (CMSA). The award, established in 1993 to recognize an outstanding leader, will be presented to Catherine at CMSA’s 19th Annual Conference in June. Congratulations on this outstanding national recognition!
Dr. Martha Furie elected Vice President of the American Society for Investigative Pathology (ASIP) for 2009. Dr. Furie, Department of Pathology and the Department of Molecular Genetics and Microbiology, will later serve as President-Elect for 2010 and as President of the ASIP for 2011. The ASIP is dedicated to the discovery, advancement, and dissemination of knowledge in experimental pathology and related disciplines. Dr. Furie’s appointment to this prestigious position brings great credit to the Stony Brook University School of Medicine.
Nursing alums honored. Rosemary Mahan, RN, Certified Pediatric Nurse Practitioner in the Division of Pediatric Hematology/Oncology, received the Stony Brook University School of Nursing Distinguished Alumnus Award on March 28. Rosemary received this prestigious award along with fellow alumna, Donna Nickitas, RN, PhD, Professor and Graduate Program Specialty Coordinator, Nursing Administration at Hunter College, Hunter-Bellevue School of Nursing. Congratulations.
Environmental Health and Safety recognizes King and Queen of Green. During the March Department Head Meeting, Fred Luebke, Materials Management, and Jeannene Strianse, Pharmacy, were recognized as SBUMC’s King and Queen of Green. Fred was selected for his accomplishments in reprocessing medical equipment. Through Fred’s efforts, the Hospital reduced waste by 7,448 pounds in 2008 and saved the Hospital $230,877. Jeannene was chosen because of her efforts in proper waste disposal and assistance in environmental protection programs.
Stony Brook University professional honored at annual Women’s Recognition Celebration. Vanessa J. Herman, Assistant Director, Governmental Relations at Stony Brook University, was honored by the Town of Brookhaven at the 23rd Annual Women’s Recognition Night. Vanessa was recognized for her outstanding work in the field of government, and was one of eleven women honored. Vanessa represents Stony Brook University, interacting with elected officials and their staff, and with national higher education organizations such as the Association of American Universities (AAU) and the Association of Public and Land-grant Universities (APLU—formerly known as the National Association of State Universities and Land-Grant Colleges/NASULGC).
The culmination of Heart Links is celebrated. The Nutrition Division of the Department of Family Medicine marked the end of one of its Heart Links grants (a five-year grant from the New York State Department of Health) with a “graduation” breakfast for the schools funded under the grant. Stony Brook hosted the breakfast with the Suffolk County Department of Health and Eastern Suffolk BOCES. Heart Links is a community nutrition project created to reduce the risk of obesity and cardiovascular disease. This project has been recognized by New York State Health Commissioner Richard F. Daines, MD.
SBUMC proposes expansion of the WIC Program. The Nutrition Division of Family Medicine has proposed continuation and expansion of the WIC program (the Special Supplemental Nutrition Program for Women, Infants, and Children) to include sites in Patchogue, Hauppauge, Wyandanch, Southold, and the Medical Center’s new Women and Infants Center. The proposal includes a request to run a supplemental nutrition program for the elderly, which would distribute food and provide nutrition education at mobile sites in Suffolk and Nassau Counties via vans. The grant is for approximately $3.2 million a year for five years.
PATIENT SATISFACTION
SBUMC employee satisfaction survey shows increase in overall score. In efforts to improve employee satisfaction and subsequently, patient satisfaction, SBUMC worked with Press Ganey to survey Hospital staff. Results were presented to Department Heads in April, and meetings with staff to inform them of the survey results that are taking place. Action plans to address improvement opportunities are expected to be completed by the end of May. It is noteworthy to report an increase in the overall satisfaction score and that three-quarters of our workforce believe that positive change will result as a consequence of the survey—testaments to the accomplishments achieved to date and our collective commitment for positive change.
Breast Care Center scheduling project is underway. The Carol M. Baldwin Breast Care Center, Radiology, and Management Engineering are collaborating to streamline scheduling of diagnostic mammography and ultrasound appointments at the Breast Care Center. The project is focusing on developing a more effective mechanism for matching demand (appointments requested) with capacity (radiologist availability), and increasing the ability for Radiology schedulers to provide diagnostic appointments on demand.
Urgent Matters collaborative focuses on patient flow in Emergency Department (ED). Members of the Health Research and Educational Trust and The George Washington University Medical Center for Healthcare Quality made a site visit to SBUMC on March 24. SBUMC participates in the Urgent Matters Collaborative to develop strategies to improve patient flow and reduce emergency department crowding. Urgent Matters is working with the U.S. Agency for Healthcare Research and Quality (AHRQ) and Health Research and Educational Trust (HRET), an affiliate of the American Hospital Association, to push quality improvement and performance measurement in the ED to the next level.
PATIENT SAFETY
SBUMC’s Quality and Patient Safety Web site is unveiled. Transparency of quality and patient safety outcomes helps to invigorate quality improvement efforts and provides relevant information to the public about Hospital core measures and patient satisfaction outcomes. As part of our journey to become a high reliability organization, a Quality and Patient Safety Web site is established on the Internet and Intranet (StonyBrookMedicalCenter.org/QualityandSafety/), which provides SBUMC’s outcomes for core measures (acute myocardial infarction, congestive heart failure, surgical care, and pneumonia), inpatient mortality, chart elements signifying potential quality concerns, and inpatient discharges. It also provides Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, which focus on patient satisfaction outcomes.
SBUMC tells an improvement story on IHI Web site. SBUMC was invited to submit an improvement report to the Institute for Healthcare Improvement (IHI) highlighting the Surgical Intensive Care Unit’s (SICU) efforts in glucose control. SICU has successfully implemented strategies to reduce complications and to tighten glucose control. The improvement story is listed in the results section on IHI’s Web site. Click here to visit web site.
Standardizing chest tube insertion practices to improve patient safety. After the success of a program to standardize education and certification processes for central line insertion, chest tube insertion was identified as the next medical procedure for standardization. A task force composed of nurses, physicians, and administrators are evaluating the current process and recommend a standard policy and approach to certification based on best practices. The proposed policy and procedure was reviewed and approved by the Graduate Medical Education Committee in January. The process will be tested late spring and is expected to be effective for incoming medical staff beginning July 1.
Clinical nutritionist workload study is conducted. Management Engineering is working with Food and Nutrition Services to evaluate the clinical nutritionists’ workload to ensure that they are able to meet patient care and performance goals, while accommodating all essential documentation requirements. Study results may pinpoint areas for improvement in workflow and help redesign a staffing model adapted to the recent changes in EPR and CBORD documentation requirements.
Patient safety rounds provide safer environment. Since May 2008, the Patient Safety Committee has endorsed and implemented Patient Safety Walk Rounds. Dr. Joseph DeCristofaro and Carolyn Santora, co-chairs of the Patient Safety Committee, conduct rounds monthly, often accompanied by a member of the Executive Staff or a Senior Executive Group. The purpose of these rounds is to increase mutual understanding between senior leaders and front-line staff about patient safety issues, identify safety issues, and identify how we can improve care. By soliciting feedback from those best able to tell us what safety issues exist, we can improve our processes in a positive way.
Crew resource management pilot program takes off. Part of becoming a high reliability organization involves improving communication among team members. Crew Resource Management (CRM) allows teams to use specific teamwork and communication behaviors, and implement the use of safety tools (such as protocols, checklists, etc.) to detect small errors before they become serious or even fatal mistakes. In April, training sessions were provided to interdisciplinary teams from different Hospital units. CRM techniques learned from these sessions will be applied to high-risk processes to enhance communication and safety.
Surgical safety checklist. As part of SBUMC’s focus on the use of Crew Resource Management (enhancing communication in a team context), and in conjunction with the World Health Organization and the Institute for Healthcare Improvement, Dr. Frank Seifert, Kathy Scheriff, Nurse Manager, OR, and Mary Lee Schroeter, CQI, spearheaded SBUMC’s participation with “SPRINT” day on April 1. SBUMC participated with more than 800 institutions nationally to use a formal communication process to ensure that evidenced-based patient safety practices are utilized. Based on input from multiple interdisciplinary teams, a surgical checklist was formed. Several educational sessions were conducted in April, and the checklist is in pilot stages.
Posters presented at the American College of Cardiology (ACC)-National Cardiovascular Data Registry (NCDR) Annual Meeting. Three of the fourteen poster presentations accepted at last month’s National Cardiovascular Data Registry annual meeting were produced by SBUMC’s Decision Support Services (DSS) cardiac staff. Special acknowledgement for quantity, in addition to quality was recognized, as the poster “Improvements in Quality of Care at SBUMC Driven by Participation in the NCDR CARE Registry” was chosen one of the “Three Best” posters displayed. Cynthia Indelicato, DSS, was recognized as one of a small number of carefully hand-selected beta testers for the updated version of the ICD registry.
American Journal of Medical Quality (AJQM) article focuses on use of SBUMC reports to improve performance. An abstract, authored by Decision Support Services staff who work with The Joint Commission/CMS core measures, with collaboration from members of the Heart Failure Service and Emergency Department, was published in a supplement to the American Journal of Medical Quality for the March/April edition. The abstract, “Using a Wide Range of Reports Based on the University HealthSystem Consortium (UHC) Core Measure Database to Drive Accountability at Stony Brook University Medical Center (SBUMC),” was based on a poster presented at UHC’s 2008 Quality and Safety Fall Forum last September.
Celebrating and communicating Failure Mode and Effect Analysis (FMEA) outcomes. Dr. Steven L. Strongwater requested that all department heads and nurse managers attend a FMEA training program that demonstrates how to use FMEA tools to conduct proactive risk assessments for high-risk processes. As a result, there are multiple FMEAs being discussed and implemented Hospital-wide. Special forums are being scheduled so that department heads and nurse managers can share the findings and process changes from departmental FMEAs and discuss the focus of the next FMEA, as this will be an ongoing process.
Quality Assessment Review Board meets in March. The Quality Assessment Review Board, chaired by Matthew Cody, met in late March to discuss the Patient Safety Quality Improvement Act of 2005, patient safety organizations, and patient safety reporting. Updates from the Quality and Strategic Options Subcommittees were shared, as well as updates on the Electronic Patient Record/Computerized Physician Order Entry.
SBUMC to participate in University HealthSystem Consortium (UHC) Readmissions Benchmarking Study. Reducing readmissions represents an opportunity to increase the quality of care, reduce healthcare costs, and increase patient satisfaction. A 2007 report to Congress found that 18 percent of Medicare patients were readmitted within 30 days of discharge, accounting for $15 billion in spending. As readmission rates are coming under increasing scrutiny from regulators and other external quality groups, this pervasive problem requires a comprehensive approach based on best practices. This benchmarking project will look at innovative strategies aimed at identifying patients at highest risk for readmission. Data collection is expected to begin early this month.
COMMUNITY CONNECTIONS
SBUMC celebrates Donate Life Month. The Medical Center hosted a variety of events during April, Donate Life Month. Three organ donor registration drives were held. For those who would like to enroll in the Registry, please visit the Donate Life Web site at www.health.state.ny.us/professionals/patients/donation/organ. On April 15, members of the Hospital staff participated in the Donate Life Month Walk on West Campus. The Organ Donor Medal Ceremony was held at the Medical Center on April 20. Donor Medals of Honor were presented to three individuals, whose family member gave the ultimate gift, the gift of life. SBUMC was congratulated by Elaine Berg, CEO, New York Organ Donor Network, for its exceptional organ donor efforts.
Community leaders meet. Dr. Steven Strongwater hosted the third Community Leaders Roundtable on April 13. The group is made up of influential members of the community representing school districts, civic associations, not-for-profit community organizations, the legal community, and health advocates. Roundtable members were impressed by the work being done at SBUMC and offered valuable suggestions about how to improve services to the community. Meetings will be held on a regular basis. If you would like to suggest individuals who might be interested in attending, please forward them to Michael McClain, Associate Director for Community Affairs.
Burn Center Recognition Day. The Burn Center at SBUMC and the Suffolk Country Volunteer Firefighters Burn Center Fund will host Annual Burn Center Recognition Day on Sunday, May 17 at 1:00 pm at SBUMC. Burn Center staff will receive well-deserved awards and the community will be acknowledged for its generous financial support.
Community event keeps unwanted medicines out of Long Island waters. SBUMC was a lead participant in the Return Unwanted Medicines program sponsored by New York Sea Grant on April 18. Members of the community visited the Setauket Firehouse to return unwanted or expired medications for proper disposal and to prevent them from being introduced into the water supply.
SBUMC staff recognized for community service. The Michael A. Maffetone Community Service Awards ceremony on April 24 honored 338 members of the Medical Center staff who performed community service on behalf of the Hospital in 2008. For their extraordinary commitment of time, Lynette LeePack-May, NP, Cancer Center, was honored as Speaker of the Year, and Lawrence M. Loewy, RN, Emergency Department, was honored as Outstanding Provider of the Year. The Michael A. Maffetone Community Service Award was presented to Dr. Shetal Shah, a neonatologist in the Department of Pediatrics, for his work in improving newborn and infant care in the developing world. The Michael A. Maffetone Community Service Grant was awarded to Midnight Run, a not-for-profit organization serving the homeless. Congratulations to our honorees and many thanks to all who give of their time to provide valuable education throughout our community.
National Volunteer Week (April 19-25) In 2008, volunteers at SBUMC donated over 50,000 hours of their time. These individuals provide a valuable service and contribute to the overall well being of patients and their families. Let the spirit of this observance last beyond the week by remembering to take a moment to acknowledge the assistance our volunteers provide and extend an extra special thank you to those with whom you have contact.
SBUMC to establish community gardens. The Family Medicine Nutrition Division was awarded a New York State Department of Health five-year grant to begin a project that will establish community gardens in low-income neighborhoods. As part of the project, the Division will sub-contract an organic farmer on the East End of Long Island to train community representatives in the art of gardening. The goal is that the gardens will grow into sustainable CSAs (community supported agriculture) in these communities.
Last Touch
Have you faced a seemingly unsolvable problem? A challenge so large, that it simply stands in your way? Something, perhaps, that forces you to make a decision or act in a manner that could define or redefine your life or the lives of people close to you? A real problem. As Americans, we are facing one of these moments now. Hundreds of thousands of people are losing their jobs. Before this recession is over, literally millions of people will be out of work. This is a problem we cannot walk away from.
When you hear about a problem like this how should you react? In the case of the economy, we have heard this so many times, perhaps you are numb, so you don’t react to it at all. Or you put it aside hoping this particular problem simply passes you by. Should you react? The answer will certainly say something about you as a person. As healthcare providers, we are born to care, so we have to react, don’t we?
Not everyone will react. There are some who would gladly share their food with the hungry, and others who won’t. Let’s face it, it takes courage to face a really big problem. And how can a small act of kindness solve such a “big problem”? This is, of course, a rhetorical comment because we all know that a series of small acts, often by just a few dedicated people, has indeed changed the world. So what is your role in facing down this economic crisis? It lies in small acts of kindness; in creating hope for those facing adversity; in some acts of sacrifice for the sake of the greater good; in creating a sense of optimism and hope rather than one of fear and panic; in becoming a part of the solution rather than adding fuel to “the problem.” Perhaps it is as simple as making your voices heard.
Using resources wisely is one of SBUMC’s five simple rules of work. Shouldn’t our public policy reflect these same values? You can make a difference.
Service to others is the rent you pay for living on this planet.
— Marian Wright Edelman
The entire population of the universe, with one trifling exception, is composed of others.
– John Andrew Holmes
We cannot live only for ourselves. A thousand fibers connect us with our fellow man.
– Herman Melville
Be kind, for everyone you meet is fighting a hard battle
–Plato
Steven L. Strongwater, MD
Chief Executive Officer
Stony Brook University Hospital
Patients First—World-Class Processes—Teamwork—Growth—Use Resources Wisely
